Angioplastia primaria optimizada: comparación de tres estrategias de administración de ABCIXIMAB intracoronario y sus efectos sobre el tamaño del infarto valorado mediante resonancia magnética cardíaca
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2017
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03/02/2016
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Universidad Complutense de Madrid
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Se ha demostrado ampliamente que el intervencionismo coronario percutáneo (ICP), cuando está disponible de forma inmediata, es el tratamiento de elección del Síndrome Coronario Agudo con elevación del segmento ST (SCACEST). Existe suficiente evidencia para afirmar que la angioplastia primaria es superior a la trombolisis intravenosa consiguiendo un mayor grado de permeabilidad de la arteria, reduciendo el riesgo de reoclusión y de reinfarto. Todos estos efectos se traducen en mejora de la supervivencia posiblemente por la reducción en el tamaño del infarto evitando el remodelado negativo (1,2). Durante las últimas tres décadas los estudios han demostrado el papel crítico de la reperfusión temprana, completa y mantenida de la arteria responsable del infarto (ARI) (3). Sin embargo, a pesar de las nuevas técnicas en el ICP, las redes asistenciales con reducción en los tiempos de traslado y la generalización de la ICP primaria, la reducción de eventos cardiacos se han estancado (4). La justificación de esta discordancia en los resultados puede estar en que la revascularización epicardica (TIMI 3), que se consigue en más del 90% de los procedimientos, no es sinónimo de reperfusión miocárdica, que es adecuada sólo en un 50% de los casos (5-8). Esta reperfusión inadecuada del miocardio isquémico podría ser causada por edema miocárdico, espasmo microvascular, pérdida de la integridad microvascular o la embolización de material trombótico y restos de placas hacia la microcirculación, entre otros (9). Queda claro que en el tratamiento del infarto es tan importante mantener abierta la arteria de forma permanente como conseguir una perfusión miocárdica adecuada...
It has been widely proved that primary percutaneous coronary intervention (PCI), when it is immediately available, is the firstly chosen treatment for ST-segment elevation myocardial infarction (STEMI). Enough evidence exists to confirm that primary angioplasty is better than thrombolysis because it can confer more rapid and complete revascularization, reaching a higher level of permeability in arteries and reducing the risk of reinfarction and a new obstruction. All these effects help survival improve, possibly because of the reduction in infarct size, and avoid negative remodeling (1,2). In the past three decades, studies have shown that early, complete and held reperfusion on the artery responsible for the myocardial infarction is vital (3). Nevertheless, in spite of new techniques in PCI, reduction of time at assistance programs and generalization of primary PCI, the reduction of heart events has become stagnant (4). The reason of the discrepancy in results may be that epicardial reperfusion (TIMI 3 flow), which is reached in more than 90% of procedures, is not a synonym for myocardial reperfusion, which is only appropriate at 50% of cases (5-8). This inappropriate reperfusion in the ischemic myocardium could be produced by myocardial edema, vasoconstriction, microvascular integrity loss or embolization of particulate debris with obstruction of the coronary microcirculation, among others (9). It is clear that, in acute myocardial infarction (AMI), keeping the artery permanently open is as important as reaching an appropriate myocardial perfusion...
It has been widely proved that primary percutaneous coronary intervention (PCI), when it is immediately available, is the firstly chosen treatment for ST-segment elevation myocardial infarction (STEMI). Enough evidence exists to confirm that primary angioplasty is better than thrombolysis because it can confer more rapid and complete revascularization, reaching a higher level of permeability in arteries and reducing the risk of reinfarction and a new obstruction. All these effects help survival improve, possibly because of the reduction in infarct size, and avoid negative remodeling (1,2). In the past three decades, studies have shown that early, complete and held reperfusion on the artery responsible for the myocardial infarction is vital (3). Nevertheless, in spite of new techniques in PCI, reduction of time at assistance programs and generalization of primary PCI, the reduction of heart events has become stagnant (4). The reason of the discrepancy in results may be that epicardial reperfusion (TIMI 3 flow), which is reached in more than 90% of procedures, is not a synonym for myocardial reperfusion, which is only appropriate at 50% of cases (5-8). This inappropriate reperfusion in the ischemic myocardium could be produced by myocardial edema, vasoconstriction, microvascular integrity loss or embolization of particulate debris with obstruction of the coronary microcirculation, among others (9). It is clear that, in acute myocardial infarction (AMI), keeping the artery permanently open is as important as reaching an appropriate myocardial perfusion...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 03/02/2016